This qualitative study, undertaken in Australia, had four aims: 1) to produce a minimum dataset to assist paramedics in clinical handover; 2) to outline attributes of effective and ineffective handover; 3) to determine feasibility of advanced data transmission; 4) to identify how best to display data in trauma bays.
Through purposive sampling, 27 participants were identified including 10 paramedics (6 mobile intensive care ambulance (MICA) paramedics and 4 road paramedics) all of whom had experience of handing over critically injured trauma patients to a trauma service; and 17 trauma team members (12 doctors, and 5 nurses) who worked in a variety of specialities.
Using semi-structured interviews, the researchers explored several areas: the process of handover itself, content of handover, data transmission, and data display.
During the interview, participants were asked to comment on the strengths and limitations of an existing handover template known as MIST (M=mechanism of injury/illness; I=injuries, either actual or suspected; S=signs, including observations and monitoring, T=treatment given) so that the researchers could subsequently tailor the template's content more specifically to trauma patients in civilian settings.
Analysis of the interviews was informed by grounded theory methodology resulting in the identification of three core themes: data content; data transmission; data display.
In relation to data content, only 2 paramedics and 9 of the trauma team were familiar with the MIST framework for clinical handover. There was, however, consensus that the template contained appropriate content although some suggestions were made to enhance the framework by including additional information, for example, oxygen saturation levels; estimated time of entrapment (if appropriate); body temperature, etc.
In relation to data transmission, participants highlighted several factors that they considered made a contribution to effective handovers such as an ability to be succinct, having previous experience; and having appropriate personnel available to receive the handover. An ineffective handover was seen by participants as occurring when unnecessary and/or too much information was handed over, and/or the handover was interrupted. Three paramedics identified that dismissive attitudes from receiving staff impeded an effective handover.
Participants were positive about the potential for electronic data transmission as a way to reduce repetition of information; enable better preparation of the receiving unit through the pre-alert, reduce information loss. On the other hand, there were also concerns about data security, time constraints, and the potential loss of focus on the patient with an increased focus on technology. Participants emphasized the need for this type of activity to be carried out without disrupting or delaying patient care.
With regard to data display in the ED, most hospital staff thought it could reduce repetition and avoid information loss especially if the patient required input from a variety of different specialists, although again there was concern that potentially the clinician's focus would be on the screen rather than on the patient.
Clearly there are limitations to the study which the researchers recognize. For example, they used paramedics who were experienced in the clinical handover of trauma patients and this may have influenced recommendations as to which elements of the MIST template needed to be added or removed, as less experienced staff may have made different suggestions. Another limitation is that the study focused on development of one framework (MIST) and this restricted exploration of other possible methods to improve clinical handover.
However, this research makes an interesting contribution to the complex area of clinical handover by further increasing our understanding of the issues involved and through adaptation and development of the MIST template. Further investigation is required before adopting the revised template, as this tool needs careful evaluation to assess what impact it has on patient care and how best to use it in clinical settings.
